Barrier to telemedicine? Many states restrict prescriptions authority

Many in the healthcare industry believe that telemedicine holds the key to solving some of America’s most pressing healthcare problems, namely access and expense.

Video conferences between doctors and patients, for example, are quicker, easier and more convenient for both parties than traditional in-office visits, the thinking goes.

But many states restrict doctors’ ability to prescribe medicines to patients they’ve never seen in person, which potentially sets up a barrier to telemedicine adoption.

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“Most of the state medical laws were written a long time ago and haven’t been adjusted for today’s world,” said Gary Capistrant, senior director of public policy with the American Telemedicine Association. “Certainly, these issues are an impediment to telehealth.”

Ohio is one state that requires doctors to have a preexisting relationship with a patient and have examined that patient in order to prescribe medicine, said Sally Diebolt, general counsel for the State Medical Board of Ohio, which regulates and licenses physicians in the state. For Ohio, this restriction on prescribing is a patient safety issue, she said.

“The medical board is not anti-telemedicine,” she said. “Every Ohio physician’s license includes the ability to do telemedicine, but you can’t prescribe to a person you’ve never personally examined.”

Ohio certainly isn’t the only state that requires doctors to have a preexisting relationship with a patient to prescribe medicine. HealthSpot, a Columbus, Ohio-area telemedicine kiosk company that is directly affected by these types of regulations, said its internal research indicates that 34 states have similar laws, CEO Steve Cashman said.

When a patient comes to one of HealthSpot’s Care4 Station kiosks and hasn’t been examined beforehand by any affiliated doctors, the kiosk’s software directs the patient to the nearest clinics where she could receive care, Cashman said.

“It won’t affect our business that much, or the majority of our patients,” he said of the prescription restriction. The idea is that most patients using HealthSpot kiosks will do so to visit doctors they’ve previously seen, Cashman said.

Still, it’s not difficult to imagine a patient unfamiliar with the restriction showing up at a HealthSpot-like kiosk hoping to receive care and a prescription, learning that that’s not an option, and then souring on the telemedicine kiosk experience. In this scenario, that’s potentially a customer the telemedicine company would never get back.

Ohio’s largest doctors’ group, the Ohio State Medical Association (OSMA), is a bit more ambivalent about the requirement that doctors must have previously physically examined a patient in order to prescribe him medicine.

OSMA spokesman Jason Koma said it’s “premature” for the organization to take an opposing or supporting position until the issue is taken up for consideration by the state medical board.

However, OSMA is familiar with companies like HealthSpot, and Koma praised the concept.

“It appears to be an innovative idea that attempts to tackle some concerns with the healthcare system, like access to care,” Koma said. “At this point, it remains to be seen whether they can achieve their goals without compromising patient safety.”

Asked to specify OSMA concerns related to patient safety, Koma said: “The real question remains: Is it possible to deliver high-quality care through this type of mechanism without compromising care coordination and compromising the ability to have the proper physician-patient interaction?”

As telemedicine proliferates, it seems that more and more states will have little choice but to figure out their own answers to those questions.